Future murky for Nashville General Hospital at Meharry

Public hospital's finances put facility in serious peril

Jan. 31, 2014

Mary Bufwack

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Now that Nashville officials have announced an agreement to spin off a nursing home and assisted care center to the private sector, they still have to decide what to do about the public hospital.

The future of Nashville General Hospital at Meharry remains unresolved after Metro officials in 2012 floated the possibility of halting or limiting inpatient services, then walked away from those plans in the face of public opposition. Key leaders involved in that deliberation — options that were spelled out in a report from the Atlanta-based hospital consulting firm Alvarez & Marsal — are no longer at the table. The hospital is still struggling financially and cannot count on any expansion of Medicaid in Tennessee to offset its losses from providing care to the poor and uninsured.

Davidson County taxpayers help pick up the tab. The subsidy from Metro government this year is $33.5 million.

“We do have to settle on where we’re going, what we’re going to do and how we’re going to build the services,” said Mary Bufwack, interim chairwoman of the Metropolitan Nashville Hospital Authority board. “We need a great deal of focus.”

Waverly Crenshaw recently stepped down as chairman of the board after Mayor Karl Dean appointed him to another commission. The mayor has not filled the vacant spot. And the board has not elected a permanent chairman.

Dr. Wayne J. Riley, the former head of Meharry Medical College who adamantly opposed the hospital’s downsizing, resigned last year and has been replaced by A. Cherrie Epps as president.

Jason Boyd, the hospital’s chief executive officer, submitted his resignation in December and was supposed to leave the post today. However, he has agreed to continue serving at the helm while the city moves forward with plans to turn over control of Bordeaux Long-Term Care and Knowles Home Assisted Living facilities to private operators — a move that would free up an additional $10.5 million in annual subsidies from the city.

While one city councilman has proposed transferring that money to the hospital, no decision has been made. Before the Metro Council can get to that point, it has to first approve the spinoff of the nursing home and assisted care center — something that Dean’s administration first publicly proposed last April.

“Obviously, the city has a lot of competing interests for finances,” Boyd said. “We are part of that. The $10.5 million in savings ultimately might sound like a small number, but we think it goes a long way with helping the city meet its goals, and we are hoping that we are one of those goals.”

The public hospital needs more than subsidies to operate. It also needs capital to upgrade imaging equipment and stay current with medical technologies.

While hospital officials had been hopeful Medic­aid expansion in Tennessee would mean new revenue, that is not a scenario they can count on.

“We have to have a strategic plan that is independent of that,” Bufwack said. “It cannot be in any way ‘Let’s just hold on until that happens.’ ”

The Alvarez & Marsal report is not the strategic plan that the board is most likely to use, she said.

“Certainly, their plan gave us a good basis for decision making,” Bufwack said. “That doesn’t necessarily mean we have to adopt any one of their plans. ... I think there is some excellent groundwork there, but no, we will not be following any specific road map that they had laid out. But it does begin to give us a feel for all the options available.”